Primary Retinal Detachment

Post-Gonin Era 15
Intraocular Tamponade
Another technique to help appose retina and choroid that could be
used in conjunction with other procedures was injection of air into
the vitreous cavity. Originally described by Ohm in 1911 and then
by Rohmer in 1912, injection of air at the end of the operation was
adopted by Arruga in 1935,and to close retinal breaks by Rosengren
in 1938 [32, 34, 139]. Rosengren carefully localized retinal breaks,
then placed penetrating diathermy in a pattern covering an area
6–7 mm in diameter with drainage of subretinal fluid. He injected
air into the vitreous cavity, then positioned the patient postoperatively
such that the air bubble closed the retinal breaks and apposed
the retina to the RPE. Rosengren reported successful retinal
reattachment in 75% of 300 cases with the technique [45].
Later Norton concluded that large breaks may respond better to
tamponade by air than by a scleral buckle alone; however, air did
not persist long enough in the eye [140]. He introduced sulfur
hexafluoride (SF6) gas for internal tamponade of retinal breaks.
Pure SF6 expands approximately twice its injected volume in the
eye and persists twice as long as a comparable air bubble. Inert perfluorocarbon
gases, introduced by Vygantas (C4F8) and Lincoff
(C2F6, C3F8, C4F10), expanded more and lasted even longer than
SF6 in the eye [141, 142].
Cibis in 1962 was the first to report the use of silicone oil for
treatment of retinal detachment [143]. The complications of silicone
oil made its usage unfavorable at that time. Haut in 1978 introduced
the use of silicone oil with vitrectomy [144]. Zivojnovic
became the major advocate of silicone oil in combination with
“retinal surgery” (relaxing retinectomy) to treat severe proliferative
vitreoretinopathy and traumatic retinal detachments [145].
Parke and Aaberg first reported the technique of argon laser endophotocoagulation
in conjunction with vitrectomy, retinectomy,
and intraocular gas for the management of PVR [146]. Development
of air pumps was also an important landmark, so retinas
could be reattached with a fluid-air exchange in a controlled fash-